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Drop-Off Treatment/Hospitalization Authorization Form

Sugar Land Veterinary Clinic

Contact's Name

Contact's Cell Phone Number

Contact's Email Address

Person to Contact for Questions, and for Pickup and Discharge (if different from above):

Pet's Name

Pet's Sex

Pet's Sex
A
B
C
D
E

Pet's Color/Special Markings

Any need for a special use of caution with patient?

Reason(s) for drop-off:

Current patient medications and the frequency they are given:

Did patient have any medications today?

Did patient have any medications today?
A
B

When was the last time the patient had a meal?

List the vaccines and the date they were last administered:

ATTENTION: I understand that unless my pet is here for a sick-patient visit/treatment that I will be required to update the Rabies Vaccine today.

ATTENTION: I understand that unless my pet is here for a sick-patient visit/treatment that I will be required to update the Rabies Vaccine today.
A
*It is required by Texas State Law if the pet is not currently up-to-date.

Previous Medical History - including Illnesses, Traumas, & Surgeries:

Any additional notes for the doctor?